Follow the steps to successfully complete the application

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the applicant information section. Provide your first name, middle name, last name, date of birth, address, apartment number (if applicable), city, state, and zip code. Ensure all details are accurate.
3. Next, complete the applicant driver’s license information section. Enter your Florida driver's license number and, if applicable, the license number from another state.
4. Proceed to the applicant vehicle information section. Fill in the vehicle year, make, model, VIN (Vehicle Identification Number), and permanent license plate number. Indicate the name of the person who the vehicle is registered to.
5. Attachments are required. Include a copy of your vehicle insurance card and a copy of the paid adaptive equipment invoice that proves the vehicle was modified with accessibility equipment.
6. Review the terms and conditions stated on the form regarding the responsibility for the decal and the consequences of providing false information. Affix your signature and write the date.
7. The physician’s or adjudication officer’s certification must be completed as well. Ensure this section is filled out properly. The physician or adjudication officer needs to sign and date this section.
8. Provide the physician’s or adjudication officer’s information, including their name, medical license number, and contact details.
9. Once all fields are completed and the required documents are attached, double-check for accuracy before finalizing your application.
10. Although the application must be mailed, after completing the form online, you can save the changes, download, print, or share the filled form according to your needs.

Complete your application online today and ensure a smooth process.